title: Unrelated donor peripheral blood stem cell transplants incorporating pre-transplant in-vivo alemtuzumab are not associated with any increased risk of significant acute or chronic graft-versus-host disease.
abstract: There is little information published comparing peripheral blood stem cells (PBSC) with bone marrow (BM) as the stem cell source in the long-term outcome in recipients of T-cell depleted (TCD) unrelated donor (UD) transplants. We present retrospective outcome data on 306 recipients of myeloablative, human leucocyte antigen-matched UD allografts using pre-transplant in-vivo Alemtuzumab. Transplants were performed between 2000 and 2007 for chronic myeloid leukaemia in first chronic phase and acute leukaemia in first or second complete remission; 184 patients received BM and 122 PBSC. The median age was 28·9 years (<1-58) and the median follow-up was 48 months. Overall survival at 8 years was 53%. The incidence of acute graft-versus-host disease (GvHD) was significantly higher in PBSC (65%) than BM recipients (49%; P=0·012). This represented only grade 1 GvHD with no difference in grade II-IV aGvHD (BM 23% PBSC 24%). The incidence of chronic GvHD, either overall (BM 47%, PBSC 49%) or extensive (BM 15%, PBSC 13%) was not increased with PBSC. The incidence of relapse, non-relapse mortality and survival were not significantly different. Whilst accepting the limitations of retrospective analyses, we suggest the increased risk of GvHD in recipients of PBSC in T-replete transplants is offset by in-vivo Alemtuzumab, and that either stem cell source can be used with good outcomes in this setting.
authors.affiliation: Anthony Nolan Trust, London Royal Marsden Hospital, London Imperial College, London, UK. bshaw@doctors.org.uk
authors.forename: Bronwen E
authors.initials: BE
authors.lastname: Shaw
authors.forename: Jane F
authors.initials: JF
authors.lastname: Apperley
authors.forename: Nigel H
authors.initials: NH
authors.lastname: Russell
authors.forename: Charles
authors.initials: C
authors.lastname: Craddock
authors.forename: Effie
authors.initials: E
authors.lastname: Liakopoulou
authors.forename: Michael N
authors.initials: MN
authors.lastname: Potter
authors.forename: Robert
authors.initials: R
authors.lastname: Wynn
authors.forename: Brenda
authors.initials: B
authors.lastname: Gibson
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Pearce
authors.forename: Keiren
authors.initials: K
authors.lastname: Kirkland
authors.forename: Julia
authors.initials: J
authors.lastname: Lee
authors.forename: J Alejandro
authors.initials: JA
authors.lastname: Madrigal
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Byrne
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality* / Q000517:prevention & control; D006801:Humans; D007223:Infant; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074323:Alemtuzumab